tci Medicare Compliance & Reimbursement - 2012 Issue 13

Medical Review: Denial Rates For Long-Stay Patients On The Rise

Ensure that your documentation for patients living longer than the six-month prognosis stands up to scrutiny.With Medicare clamping down on payments for long-stay hospice patients, you need to figure what when your patient no longer qualifies for the terminal diagnosis before an edit hits you and you are faced with a denial.Examples: Home Health & Hospice Medicare Administrative Contractor CGS has revealed the results of two edits of long-stay patients. Under edit topic code 5037T, CGS reviewed claims for hospice patients with lengths of stay greater than 730 days and denied 81 percent of reviewed claims. Under...

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